The closure of up to four obstetric units in the west and northwest is mooted in a confidential report commissioned by the HSE. The units at Ballinasloe, Castlebar, Sligo and/or Letterkenny could close as part of a reconfiguration of maternity services in the two regions, according to options set out in the politically explosive report, seen by The Irish Times.

While the HSE says no decisions have been made yet, the study by consultants the Health Partnership makes it clear that “significant changes” are needed in the way services are delivered. The development of midwife-led units, either alongside obstetric units or on a standalone basis, is recommended in the study.

A system of centralised booking for expectant mothers, which would see women directed to the appropriate centre for care “based on admission criteria”, as well as the rotation of staff through each area, are also recommended.

Fianna Fáil health spokesman Marc MacSharry, who raised the issue in the Seanad yesterday, said the report confirmed that the HSE was strongly considering dramatically downgrading maternity services at Sligo General, Mayo General and Portiuncula Hospital, Ballinasloe.

“There are reports that plans are already under way to shut down the maternity unit at Portiuncula as soon as the local and European elections are over, and transfer patients to University Hospital Galway, ” he said. “For the Government to keep this major change to our local health services a secret until after polling day is deeply cynical and deeply unfair to expectant mothers who are due their babies at Portiuncula very soon.

“If these plans go ahead, it would amount to a major downgrading of obstetrician-led maternity services in this region. It is completely unacceptable to consider shutting down the maternity unit in Sligo and forcing expectant mothers to travel hours to Letterkenny or Galway city to see an obstetrician.”

HSE officials met staff at Portiuncula last Friday, after which Tony Canavan, chief operating officer of the West/North West Hospitals Group, said no decision had been taken. Feasibility studies would have to be carried out first and early speculation was unhelpful to staff and patients, he said.

The report says the existing obstetrically led service requires urgent review. There is no agreed model of care and most of the units fall below the recommended number of 2,500 births a year needed to maintain a cost-effective and sustainable service.

While the recommended staffing ratio is one obstetrician to 350 births, the actual ratio ranges from 1:442 to 1:685 in the five units. The ratio of midwives is 1:39 when it should be 1:29, the report says.

The study sets out six main options for reconfiguration, ranging from “as is” to keeping University Hospital Galway as the hub and closing up to four of the other maternity units. However, sticking with the present configuration would present challenges of financial stability and workforce sustainability because of a shortage of trained staff, according to the report.

The closure of the maternity unit at Portiuncula is mooted in four of the six options in the report. However, this would result in long travelling distances for high-risk mothers as well as increasing demand at other units, including Mullingar. Closing Portiuncula, Mayo, Sligo and Letterkenny obstetric units would result in UHG being over the recommended size for one site, the report says.

More than 10,000 babies are born in the west and northwest each year, representing 15 per cent of the national total. Currently, women do not have to travel more than 60 minutes to a maternity unit but this could increase to 80 minutes if services are reconfigured.